Provider Demographics
NPI:1437614104
Name:SEVIER, KANDICE V
Entity Type:Individual
Prefix:
First Name:KANDICE
Middle Name:V
Last Name:SEVIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 ELLIS ST STE 1
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-3390
Mailing Address - Country:US
Mailing Address - Phone:682-877-1234
Mailing Address - Fax:682-877-1235
Practice Address - Street 1:2400 ELLIS ST STE 1
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084-3390
Practice Address - Country:US
Practice Address - Phone:682-877-1234
Practice Address - Fax:682-877-1235
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TX3895103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst